Acta Neurochir (Wien). 2025 Aug 8;167(1):218. doi: 10.1007/s00701-025-06632-2.
ABSTRACT
PURPOSE: The increasing availability of advanced neuroimaging has led to a rise in incidental findings among pediatric patients. Management strategies include immediate surgical intervention, observation or surgery upon progression. These are influenced by imaging characteristics, lesion behavior over time, patient/family preferences, and the lesion’s surgical risks. The thalamus’s eloquent location often warrants a more conservative approach. Identifying features predictive of growth could help inform clinical decisions regarding surveillance and potential intervention.
METHODS: We retrospectively analyzed 44 pediatric patients with 46 thalamic incidentalomas, assessing radiological characteristics, temporal changes, and factors predictive of progression. Progression was defined as a change in size and/or new/increased contrast enhancement. Prognostic factors for progression (demographics, initial tumor volume, extension beyond thalamus, changes in enhancement, margin characteristics) were assessed for significance.
RESULTS: Of 46 incidentalomas, 40 were followed longitudinally. Nine incidentalomas (22.5%) showed regression, while nine (22.5%) progressed. The average time to regression was 947 days, and to progression, 516 days. Three patients underwent biopsy due to progressive changes; each was diagnosed with low-grade glioma. Statistical analysis revealed that initial incidentaloma volume, extension beyond the thalamus, and contrast enhancement were significantly associated with progression (p = 0.025, p < 0.001, and p = 0.001, respectively).
CONCLUSIONS: Most pediatric thalamic incidentalomas are small, stable, and likely low-grade. However, approximately one-fifth exhibit progressive features, warranting prolonged surveillance. Larger initial volume, extra-thalamic extension, and contrast enhancement are significant predictors of progression and may justify earlier intervention. Individualized management remains essential, balancing natural history with surgical risk.
PMID:40779174 | DOI:10.1007/s00701-025-06632-2
